Cleaveland: Scrooge is alive in Tennessee

December 26th, 2013 By Dr. Clif Cleaveland
in Life Entertainment

Dr. Clif Cleaveland

An imagined scenario: The young Tennessee couple is without health insurance. Their three part-time jobs provide no health benefits. Their combined annual income barely exceeds the federal poverty level so they do not qualify for TennCare (our state's Medicaid program). They cannot afford private health insurance.

As they drive across the state to celebrate the Christmas holidays with family, the wife, who has had a cough for several days, develops fever and chills. Her cough worsens and is accompanied by sharp chest pains. They stop at the emergency room of a community hospital, where diagnostic studies confirm bacterial pneumonia. Upon discharge from the hospital they are informed that they owe the hospital thousands of dollars for her care. They face bankruptcy unless they can borrow money from family members.

Imagine capacity crowds at Neyland Stadium (102,000) and Vanderbilt Stadium (40,500) and you have the number of uninsured Tennesseans who would have been added to TennCare had Gov. Bill Haslam and legislative leaders chosen to participate in Medicaid expansion under the Affordable Care Act. By expanding eligibility to 138 percent of the federal poverty level ($15,510 for a couple, $23,550 for a family of four in 2013), Tennessee could have protected these thousands.

For states choosing to expand their Medicaid programs, the federal government would pay all of the costs for the additional covered lives for the initial three years. Thereafter, federal funds would cover 90 percent of the additional costs. For Tennessee, federal funds of $1.4 billion would have been available to cover the costs of 140,000 newly insured residents.

Haslam has proposed a deal with the U.S. Department of Health and Human Services in which federal funds would be used for purchasing private insurance for these uninsured residents. A formal request for a waiver from federal regulations has not been submitted. The issue has been unresolved for months. Meanwhile, Lt. Gov. Ron Ramsey has stated his opposition to expanding the program under any circumstances.

Sixteen percent of non-elderly Tennesseans have no health insurance, compared with 17.7 percent nationally. Texas leads the nation in uninsured residents at 26 percent; Florida is second at 25 percent. A profile of uninsured households shows that 63 percent have one or more fulltime workers; 16 percent have one or more part-time employees; 21 percent are unemployed.

Thirty-nine percent of the uninsured are younger than 35 years of age; 35 percent are 35 to 54; 10 percent are 55 to 64.

An analysis by Harvard Medical School and the Cambridge Health Alliance estimated that more than 44,000 Americans died in 2009 as a consequence of being uninsured.

If you have no health insurance, you are unlikely to have symptoms addressed until they are severe. Thus, early symptoms of potentially curable diseases go unchecked. Your cancer will go undiagnosed until it has spread. Disorders that could have been managed by an outpatient visit to a clinic deteriorate to the point that a high-cost emergency room visit is inevitable.

If you have no health insurance, many medications are unaffordable. In these days of inflation in prescription drug costs, medications may run into the hundreds of dollars per month. A distressed man phoned me before Christmas to report that his prescriptions for diabetes would cost more than $900 for a three-month supply.

While the governor dithers and legislative leaders promise obstruction, preventable deaths and bankruptcies occur. Political ideology has blocked expansion of TennCare. The money was on the table to cover the additional costs. Tens of thousands of our people would have benefited. Compassion and practicality lose. Scrooge is alive in Tennessee.